Outcomes in Bilateral Vocal Fold Immobility: A Retrospective Cohort Analysis.
Outcomes in Bilateral Vocal Fold Immobility: A Retrospective Cohort Analysis.
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DOI：
10.1177/0194599818800462
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Hillel AT
中科院分区：
文献类型：
--
作者：
Gadkaree SK;Gelbard A;Best SR;Akst LM;Brodsky M;Hillel AT
检验双侧声带运动障碍（BLVFI）、双侧声带麻痹（BVFP）和后声门狭窄（PGS）的病因具有不同临床结局的假设。确定影响无气管造口术生存率的患者特异性和手术因素。回顾性队列研究。约翰霍普金斯医学中心，2004年至2015年。对68例PGS患者和17例BVFP患者进行病历审查的病例系列。多元逻辑回归分析确定了与最后随访时气道假体依赖性和手术负担（定义为每年手术次数）相关的因素。PGS占BLVFI的大多数（76%）。PGS损伤主要发生在气管插管后（91%），而BVFP最常见的是由于医源性手术损伤双侧喉返神经（88%，P <0.001）。总体而言，在BLVFI中，66%在末次随访时无气管造口术（PGS中为62%，BVFP中为82%）。在接受手术干预拔管的患者中，88%拔管（90% PGS，80% BVFP）。与BVFP队列相比，PGS患者需要更高的手术负担才能实现拔管（3.1 ± 5.2 vs 0.71 ± 1.4，P =.002）。在PGS的多变量分析中，吸烟是气管造口术依赖的危险因素（P = 0.026）。BLVFI主要是医源性并发症。在BLVFI中有很高的气管切开依赖率，需要进行手术干预以拔管。与BVFP相比，PGS患者的总体手术负担更高，并且需要拔管。应告知PGS患者，吸烟是一种可改变的风险因素，可能会增加气管切开术依赖的风险。
To test the hypothesis that the etiologies of bilateral vocal fold mobility impairment (BLVFI), bilateral vocal fold paralysis (BVFP), and posterior glottis stenosis (PGS) have distinct clinical outcomes. To identify patient-specific and procedural factors that influence tracheostomy-free survival. Retrospective cohort study. Johns Hopkins Medical Center from 2004 to 2015. Case series with chart review of 68 patients with PGS and 17 patients with BVFP. Multiple logistic regression analysis determined factors associated with airway prosthesis dependence at last follow-up and the procedural burden (defined as number of operative procedures per year). PGS comprised the majority of BLVFI (76%). PGS injury arose primarily after endotracheal intubation (91%), while BVFP most commonly was due to iatrogenic surgical injury to bilateral recurrent laryngeal nerves (88%, P <.001). Overall in BLVFI, 66% were tracheostomy free at last follow-up (62% in PGS, 82% in BVFP). Of those who underwent an operative intervention to be decannulated, 88% were decannulated (90% PGS, 80% BVFP). Patients with PGS required higher procedural burden to achieve decannulation compared with the BVFP cohort (3.1 ± 5.2 vs 0.71 ± 1.4, P = .002). In multivariate analysis of PGS, smoking was a risk factor for tracheostomy dependence (P = .026). BLVFI is primarily an iatrogenic complication. There are high rates of tracheostomy dependence in BLVFI, with procedural intervention needed for decannulation. Compared with BVFP, patients with PGS had a higher procedural burden overall and to achieve decannulation. Patients with PGS should be counseled that smoking, a modifiable risk factor, may increase the risk of tracheostomy dependence.
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DOI：
10.4049/jimmunol.0900473
发表时间：
2009-08-15
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
--
作者：
Shaykhiev R;Krause A;Salit J;Strulovici-Barel Y;Harvey BG;O'Connor TP;Crystal RG
通讯作者：
Crystal RG
影响因子：
2.6
作者：
Halum, Stacey L.;Ting, Jonathan Y.;Merati, Albert L.
通讯作者：
Merati, Albert L.
影响因子：
3.4
作者：
BOGDASARIAN, RS;OLSON, NR
通讯作者：
OLSON, NR
影响因子：
1.7
作者：
Gardner, GM
通讯作者：
Gardner, GM
影响因子：
9.8
作者：
Reiner, Alex P.;Beleza, Sandra;Tang, Hua
通讯作者：
Tang, Hua